Add Prescription Drug Coverage

It's an election year. One sure sign is that, once again, every politician seems to favor prescription drug coverage. And yet there is a growing consensus that Congress will again duck the issue.

What gives?

If Americans overwhelmingly favor adding drug coverage to Medicare and if senators and representatives back the idea, why can't Congress respond?

One reason is money. Another is politics.

The Republican plan, scheduled for a House vote this week, would cost an estimated $310 billion over 10 years. More sweeping Democratic alternatives could cost up to $800 billion. At a time of soaring federal budget deficits, the less-expensive Republican plan makes sense, especially because the realistic alternative might be no plan at all.

Other than cost, the biggest difference involves philosophy, although not to the extent that partisans on both sides contend. Regardless of the plan, government will play a key role. Democrats want a centralized, single-provider system. Medicare would offer a drug benefit directly. Republicans prefer to have Medicare work through insurance companies to induce them to offer coverage subsidized by taxpayers.

Democrats and Republicans differ on the particulars. Under the GOP plan, Medicare participants would pay a monthly fee of $35; Democrats would charge $25. The GOP plan would exempt a single person earning $14,500 or less a year from paying the $35 fee and subsidize the monthly premium for a person earning up to $17,000. For married couples, the income threshold is $19,500 and $23,000 respectively.

Republicans would set a yearly deductible of $250; House Democrats, $100; and Senate Democrats, nothing.

The biggest difference involves out-of-pocket costs. Patients with annual drug expenses of less than $3,700 would pay considerably more out of pocket under the Republican bill, a major reason why that plan is less expensive. The government would pay the full cost beyond that amount.

Having access to prescription drugs can be a matter of life and death. An estimated one-third of the 40 million elderly and disabled people on Medicare have no drug coverage at all -- a stark fact that ought to spur Congress to do something.

Prescription drug costs have continued to spiral upward. Medicare patients spent, on average, $813 out of their own pockets for prescription drugs in 2000, a figure projected to rise to $1,051 this year.

Republicans and Democrats have lambasted each other, shouting about who really cares more about helping the elderly. The rhetoric is getting tired. Action is needed. Congress can pass a realistic prescription drug plan and build on it in future years. All that's needed now is willingness to compromise to get a bill to the president's desk.